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immunotherapy

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An immunotherapy drug can be effective in some men with advanced prostate cancer, a major trial has shown.

The phase II clinical trial, led by the Institute of Cancer Research and the Royal Marsden, involved 258 men with advanced prostate cancer who had run out of all other options on treatment.

The men had stopped responding to the main treatment options.

According to researchers, a small proportion of men, described as “super responders”, remained well even after the trial ended, despite a very poor prognosis before treatment.

Last week it was reported the same drug had proved effective in treating advanced head and neck cancers.

Immunotherapy uses our own immune systems to recognize and attack cancer cells.

The therapy is already being used as a standard treatment for some cancers such as melanomas – and being tested on many others too.

Nivolumab: Immunotherapy Drug Hailed as Game-Changer in Cancer Treatment

Bladder cancer breakthrough: New immunotherapy drug for terminal patients

The study found that one in 20 men with advanced prostate cancer responded to the drug pembrolizumab – and saw their tumors actually shrink or disappear altogether.

The study, published in the Journal of Clinical Oncology found that although a relatively small number, some of the men gained years of extra life.

A further 19% saw some evidence of improvement.

Most patients in the study lived for an average of eight months on the drug.

The most dramatic responses were seen in patients whose tumors had mutations in genes involved in repairing DNA.

Researchers are now investigating whether this group might benefit the most from immunotherapy in a larger trial.

But first, a test to pick out who will respond best is needed, so that doctors know which patients to give it to.

The number of people diagnosed with prostate cancer has been rising over the last 10 years.

This is probably because the population is getting older and more people are having PSA tests.

Around 30% of men with advanced or stage four prostate cancer survive their cancer for five years or more after diagnosis.

Last week, a separate trial found the same drug kept some people’s advanced head and neck cancers at bay for an average of two years – five times longer than under chemotherapy.

Both studies are part of a growing body of research suggesting immunotherapy could offer hope to an increasing number of cancer patients.

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According to a recent study, bacteria living deep inside the digestive system seem to alter how cancer drugs work.

Immunotherapies – which harness the body’s own defenses to fight tumors – can clear even terminal cancer in a small proportion of patients.

However, a small study by the University of Texas found those harboring a more diverse community of gut bugs are more likely to benefit.

Image source Wikipedia

Image source Wikipedia

The human body is home to trillions of micro-organisms – estimates suggest our own tissues are so heavily outnumbered that our bodies are just 10% human.

A growing wealth of studies shows these microbes can influence our immune systems and have been implicated in auto-immune diseases and allergies.

Immunotherapies are one of the most exciting breakthroughs in treating cancer. They work by taking the brakes off the immune system to help it to attack tumors more easily.

The research group compared the gut bacteria in 23 patients who responded to the therapy and 11 who did not.

The study, presented at the National Cancer Research Institute’s Cancer Conference in Liverpool, found Ruminococcus bacteria in much higher levels in those that responded to treatment.

It suggests that it may be possible to boost the effectiveness of immunotherapy by altering the balance of bacteria in the gut.

Procedures such as a trans-poo-sion – a transplant of fecal matter containing beneficial bacteria – are already used as a treatment for some diseases.

It is not yet clear if the differences in bacteria are the cause of the better response.

People with diets containing more fruit and vegetables tend to have a richer set of gut bugs, so it is possible that it is those with a healthier lifestyle that respond better to therapy.

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Nivolumab, an immunotherapy drug, has been described as a potential “game-changer” in promising results presented at the European Cancer Congress.

In a study of head and neck cancer, more patients taking the drug survived for longer compared with those who were treated with chemotherapy.

In another study, combining nivolumab with another drug shrank tumors in advanced kidney cancer patients.

Immunotherapy works by harnessing the immune system to destroy cancer cells.nivolumab-cancer-treatment

Advanced head and neck cancer has very poor survival rates.

In a trial of more than 350 patients, published in the New England Journal of Medicine, 36% treated with nivolumab (Opdivo) were alive after one year compared with 17% who received chemotherapy.

Patients also experienced fewer side effects from immunotherapy.

The benefits were more pronounced in patients whose tumors had tested positive for HPV (human papillomavirus). These patients survived an average of 9.1 months with nivolumab and 4.4 months with chemotherapy.

Normally, this group of patients are expected to live less than six months.

Early data from a study of 94 patients with advanced kidney cancer showed that the double hit of nivolumab and ipilimumab resulted in a significant reduction in the size of tumors in 40% of patients.

Of these patients, one in 10 had no sign of cancer remaining.

This compares with 5% of patients showing tumor reduction after standard therapy.

Nivolumab and ipilimumab both work by interrupting the chemical signals that cancers use to convince the immune system they are healthy tissue.

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Researchers have found that a genetically-engineered version of the cold sore virus (herpes simplex virus) could treat skin cancer.

T-Vec, the modified herpes virus, is harmless to normal cells but when injected into tumors it replicates and releases substances to help fight the cancer.

The findings, published in the Journal of Clinical Oncology, show the therapy could lengthen survival by years – but only for some melanoma patients.

The treatment is not yet licensed.

Similar “immunotherapy” treatments for melanoma are already available in the US and in Europe, but researchers believe T-Vec would be a welcome addition to these.Herpes simplex virus and skin cancer

It would also be the first melanoma treatment that uses a virus.

The latest study is the largest ever randomized trial of an anti-cancer virus and involved 436 patients from 64 centers in the US, the UK, Canada and South Africa who had inoperable malignant melanoma.

UK trial leader Prof Kevin Harrington, from the Institute of Cancer Research, London, said: “There is increasing excitement over the use of viral treatments like T-Vec for cancer, because they can launch a two-pronged attack on tumors – both killing cancer cells directly and marshalling the immune system against them.

“And because viral treatment can target cancer cells specifically, it tends to have fewer side effects than traditional chemotherapy or some of the other new immunotherapies.”

Although it has not yet been licensed, doctors are excited about the very real prospect of a brand new type of treatment for advanced melanoma – and, in the future, possibly other cancers too.

The idea of using viruses to enter and kill cancerous cells has been gathering scientific pace and kudos.

This latest study in the Journal of Clinical Oncology is the largest ever randomized trial of an anti-cancer virus and provides tantalizing evidence that the treatment concept could soon be moved into the clinic, after decades of work in the lab.

Researchers now want to do more studies to identify which patients might benefit from the treatment and whether it should be used alongside other melanoma drugs that are already approved.

Drug regulators will be watching closely and will soon make a final decision about T-Vec.

Damage to the skin by the sun’s harmful UV rays increases your risk of developing this cancer.

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According to a recent study, an antibody drug which makes a wide range of cancers more vulnerable to the body’s immune system is “exciting” and may mark a new era.

The new drug strips cancer cells of the “camouflage” they use to evade attack by the immune system.

In the most detailed study, published in Nature, some patients completely recovered from terminal bladder cancer.

The immune system is in delicate balance with some chemicals in the body encouraging a strong vigorous response, while others try to dampen it down.

Tumors can hijack this system to hide from the immune system.

One trick which tumors use is a protein called PD-L1 which is normally used to prevent autoimmune diseases.

An international team of scientists has been trialing a drug to block PD-L1, produced by the company Roche, on 68 people with advanced bladder cancer.

All the patients had tried chemotherapy and had been given six-to-eight months to live.

More than half the patients, whose tumors were using PD-L1 to hide from the immune system, showed signs of recovery.

In two patients there were no signs of cancer after the treatment.

One in ten patients responded to the experimental therapy even if PD-L1 was not present in the tumor.

Dr. Tom Powles, an oncologist at the Barts Cancer Institute at Queen Mary University of London and part of the research team, said: “There have been no new drugs for bladder cancer for 30 years.

“The tumors have developed a camouflage layer, PD-L1, and by removing the camouflage the tumor becomes identifiable.

“A subgroup of patients seems to do exceptionally well.”

Dr. Tom Powles is funded by the UK’s National Health Service (NHS) and receives no money from Roche.

The drug has been given “breakthrough therapy” status in the US and could be used widely by patients there at the end of 2015, if a larger trial shows the same results.

Much larger randomized clinical trials would be needed in order for the experimental therapy to be used in Europe.

A similar set of trials to boost the immune attack revealed at the American Society of Clinical Oncology conference in Chicago in June, showed similar therapies could improve survival in advanced skin cancer.

In a trial of 411 patients evaluating a drug, pembrolizumab – 69% of patients survived at least a year.

Those results were described as having the “potential to be a paradigm shift for cancer therapy”.

A separate study of 175 patients, led by Yale University in the US, showed responses to the drug in patients with non-small cell lung cancer, melanoma, renal cell carcinoma and other cancers.